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Dentist Name
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Patient's Name
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Last
Email
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Clinic Name
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Clinic Address
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Contact Numbers
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Deliver Date
Due Date
Upper
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Lower
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Universal Numbering System
CAD CAM
VITA MARK II (All Ceramic)
VITA ENAMIC (Hybrid Ceramic)
Implant Customized Abutment
Implant Hybrid Screw-Retained Crown
BruxZir Zirconia(USA)
KATANA Zirconia (Japan)
China Zirconia (PFZ)
China Zirconia (Solid)
PFM
Vita VMK Master CAD/CAM Designed PFM(Germany)
Noritake CAD/CAM Designed PFM (JAPAN)
Noritake Conventional PFM (Japan)
Removable
CAD/CAM Designed Cast Denture
Fully Digital Denture
Valplast Flexible Denture(Made in USA)
Acry-Tone Non Clasp Denture ( Made in Japan)
SHADE
Specific Instruction
For Fixed and Removable Prosthesis
Orthodontic
Not Selected
Clear-Aligner ( SCHEU Germany)
Clear Retainer
Indirect Bonding Tray
Chief Complaint and Specific Instructions
For Orthodontic Orders
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